Provider Demographics
NPI:1639777154
Name:BAKER, KEISA D (LCSW)
Entity Type:Individual
Prefix:
First Name:KEISA
Middle Name:D
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 24TH ST STE 2E
Mailing Address - Street 2:TRUMAN MEDICAL CENTER RECOVERY HEALTH SERVICES
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2640
Mailing Address - Country:US
Mailing Address - Phone:816-404-5840
Mailing Address - Fax:816-404-6049
Practice Address - Street 1:1000 E 24TH ST STE 2E
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2776
Practice Address - Country:US
Practice Address - Phone:816-404-5850
Practice Address - Fax:816-404-6049
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200294961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical